title: Optimizing perioperative hemodynamics: what is new?
abstract: OBJECTIVE
  Using perioperative goal-directed therapy (GDT) or peroperative hemodynamic optimization significantly reduces postoperative complications and risk of death in patients undergoing noncardiac major surgeries. In this review, we discuss the main changes in the field of perioperative optimization over the last few years.
  
  
  RESULTS
  One of the key aspects that has changed in the last decade is the shift from invasive monitoring with pulmonary artery catheters (PACs) to less or minimally invasive monitoring systems. The evaluation of intravascular fluid volume deficits has also changed dramatically from the use of static indices to the assessment of fluid responsiveness using either dynamic indices or functional hemodynamic. Finally, attention has been directed toward more restrictive strategies of crystalloids as maintenance fluids.
  
  
  CONCLUSIONS
  GDT is safe and more likely to tailor the amount of fluids given to the amount of fluids actually needed. This approach includes assessment of fluid responsiveness and, if necessary, the use of inotropes; moreover, this approach can be coupled with a restrictive strategy for maintenance fluids. These strategies have been increasingly incorporated into protocols for perioperative hemodynamic optimization in high-risk patients undergoing major surgery, resulting in more appropriate use of fluids, vasopressors, and inotropes.
authors.affiliation: Division of Critical Care, Medical School - Hospital de Base, São José do Rio Preto, São Paulo, Brazil. suzanaalobo@gmail.com
authors.forename: Suzana M
authors.initials: SM
authors.lastname: Lobo
authors.forename: Ciro L
authors.initials: CL
authors.lastname: Mendes
authors.forename: Ederlon
authors.initials: E
authors.lastname: Rezende
authors.forename: Fernando S
authors.initials: FS
authors.lastname: Dias
mesh_terms: D002407:Catheterization, Swan-Ganz / Q000706:statistics & numerical data; D005440:Fluid Therapy / Q000379:methods* / Q000706:statistics & numerical data; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D020896:Hypovolemia / Q000517:prevention & control* / Q000628:therapy; D008991:Monitoring, Physiologic / Q000379:methods*; D019990:Perioperative Care / Q000379:methods*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000517:prevention & control*